Amenorrhea or Lack of Menstrual Period

Pelvis | Obstetrics and Gynaecology | Amenorrhea or Lack of Menstrual Period (Symptom)


Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Pregnancy and breastfeeding are physiological states characterized with amenorrhea. Absence of menses is also common in childhood and menopause, these representing the unproductive years.

Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

When a woman has regular menstrual cycles, her hypothalamus, pituitary gland, ovaries, and uterus are functioning normally.


Causes of amenorrhea can be hypothalamic such as craniopharyngioma, teratoma, sarcoidosis, Kallmann syndrome, nutritional deficiency, low body weight or growth delay; pituitary causes; ovarian causes like anovulation, polycystic ovary syndrome, Turner syndrome, radiation or chemotherapy; or functional causes such as anorexia/bulimia, chronic diseases, recreational drug abuse, excessive stress, excessive exercise, birth control pills.

Additional symptoms may be present depending on the associated condition: galactorrhea, headache, increased hair growth in a male pattern, vaginal dryness, hot flashes, night sweats, or disordered sleep, noticeable weight gain or weight loss or excessive anxiety.

Diagnosis and Treatment

Tests to determine the cause of the amenorrhea are: blood tests to determine the levels of hormones secreted by the pituitary gland (FSH, LH, TSH, and prolactin) and the ovaries (estrogen), ultrasonography of the pelvis, CT scan or MRI of the head may be performed to exclude pituitary and hypothalamic causes of amenorrhea. If the above tests are inconclusive, additional tests may be performed including: thyroid function tests, determination of prolactin levels, Hysterosalpingogram, Hysteroscopy.